scholarly journals Evaluation and Management of Septic Arthritis in Emergency Department “Narrative Review”

2021 ◽  
pp. 53-60
Author(s):  
Abdulwahab Ahmed Alzahrani ◽  
Abdullah Habib H. Alluqmani ◽  
Mosab Abdullah Althaqafi ◽  
Ahmad Abdulsamad Alhamoud ◽  
Faisal Mousa Kuraydim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Arthritis ◽  
Healthcare Providers ◽  
Joint Damage ◽  
Operative Management ◽  
Current Evidence ◽  
Poor Treatment ◽  
Infective Disease ◽  
Significant Disability ◽  
Rapid Destruction

Septic arthritis (SA) is a secondary infective disease due to joints inflammation. It often appears with mono- or oligoarticular acute arthritis that frequently leads to an emergency department (ED) visit with need for prolonged hospitalization. SA is an orthopedic emergency that can threaten both life and limb due to its potential rapid destruction of the joint with fulminant sepsis, causing significant disability within hours to days. Delayed or poor treatment of septic arthritis can lead to irreversible joint damage with consequent disability in addition there to significant mortality rate. Management includes early detection and treatment with antibiotics, joint aspiration, and consultation for orthopedic surgery as potential operative management. This review aims to summarize current evidence regarding evaluation and management of septic arthritis in emergency department, and to highlight the difficulties of diagnosing and managing SA that face the healthcare providers to help overcome those difficulties and to recommend further studies to be done regarding those problems and their solutions.

scholarly journals Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19

2021 ◽  
Vol 14 (4) ◽  
pp. e242370
Author(s):  
Jiodany Perez ◽  
Stefani Sorensen ◽  
Michael Rosselli
Keyword(s):  
Emergency Department ◽  
Septic Arthritis ◽  
Glenohumeral Joint ◽  
Imaging Modality ◽  
Point Of Care ◽  
Significant Morbidity ◽  
Anchoring Bias ◽  
Septic Bursitis ◽  
Musculoskeletal Ultrasonography ◽  
Point Of Care Ultrasonography

Prompt recognition and treatment of septic arthritis are crucial to prevent significant morbidity and mortality in affected patients. During the current COVID-19 pandemic, anchoring bias may make an already challenging diagnosis like septic arthritis more difficult to diagnose quickly and efficiently. Musculoskeletal (MSK) point of care ultrasonography (POCUS) is an imaging modality that can be used to quickly and efficiently obtain objective findings that may help a clinician establish the diagnosis of septic arthritis. We report a case where MSK POCUS was a key element in establishing the diagnosis of glenohumeral joint septic arthritis and subdeltoid septic bursitis for a patient that presented to the emergency department with a fever during the era of the COVID-19 pandemic.

scholarly journals Healthcare pathways and resource use: mapping consequences of ambulance assessment for direct care with alternative healthcare providers

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sofi Varg ◽  
Veronica Vicente ◽  
Maaret Castren ◽  
Peter Lindgren ◽  
Clas Rehnberg
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Resource Use ◽  
Healthcare Providers ◽  
Healthcare Utilisation ◽  
Direct Care ◽  
Care Centre ◽  
Decision System ◽  
Geriatric Ward ◽  
Patient Pathways

Abstract Background A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. Methods The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases. Results Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department. Conclusions The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.

scholarly journals Comparison of fit factors among healthcare providers working in the Emergency Department Center before and after training with three types of N95 and higher filter respirators

Medicine ◽  
2019 ◽  
Vol 98 (6) ◽  
pp. e14250 ◽  
Author(s):  
Hongjung Kim ◽  
Juncheol Lee ◽  
Sanghyun Lee ◽  
Jaehoon Oh ◽  
Boseung Kang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Providers ◽  
Before And After

scholarly journals Transitional care models for chronic patients: preliminary results from an umbrella review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M T Riccardi ◽  
M Cicconi ◽  
W Ricciardi ◽  
M M Gianino ◽  
G Damiani
Keyword(s):  
Emergency Department ◽  
Usual Care ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Care Setting ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Current Evidence ◽  
Chronic Patients ◽  
Care Models

Abstract Worldwide, chronic diseases are burdening and the health systems need to be rethought to better manage this epidemiologic shift. One of the critical points in the care pathway of chronic patients is the transition from one care setting to another. Aim of this study is to provide an overview of the current evidence on the impact of transitional care programs on health and economic outcomes for chronic patients Medline, Web of Science and EMBASE were queried for relevant reviews using the Population-Intervention-Context-Outcome (PICO) model. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Data were analyzed using descriptive statistic, and comparison among studies carried out in European Union (EU) versus non-EU was performed (Chi-square test was used and a p < 0.05 was deemed as statistically significant) 124 reviews were assessed for eligibility and 14 were eventually included (for a total of 167 primary articles). Quality appraisal was critically low in 60% of the reviews. Both hospital readmission rate and Emergency Department (ED) visit rate were lower than those in usual care group, but this difference was significant in 40% of articles. In EU studies readmission rate was lower in 65% of cases while in non-EU ones the percentage was 51.0%, but the difference was not significant (p = 0.23). Six reviews (43%) investigated the economic impact of the transitional care: most reported an initial increase in cost due to investment in staff training and creation of organizational networks, followed by a sharp decrease in costs due to a better utilization of health services, thus leading to a reduction in overall costs. Compared with usual care, transitional care shows an overall cost reduction, even if with limited effects on re-hospitalization or ED visit rates. These findings should encourage decision makers to invest in the development of this kind of programs in order to identify models that best perform. Key messages The patient transfer supervision from one care setting to another is necessary for continuity of care, but there is no robust evidence about the better performance of transitional care models. Systematically reviewed transitional care models has been shown be more cost saving, with a moderate impact on hospital readmission or emergency department visits rates.

scholarly journals Machine-learning algorithm that can improve the diagnostic accuracy of septic arthritis of the knee

2021 ◽  
Author(s):  
Eun-Seok Choi ◽  
Jae Ang Sim ◽  
Young Gon Na ◽  
Jong- Keun Seon ◽  
Hyun Dae Shin
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Confidence Interval ◽  
Diagnostic Accuracy ◽  
Septic Arthritis ◽  
Inflammatory Arthritis ◽  
Supervised Machine Learning ◽  
Diagnostic Model ◽  
Extreme Gradient Boosting ◽  
Wbc Count

Abstract Purpose Prompt diagnosis and treatment of septic arthritis of the knee is crucial. Nevertheless, the quality of evidence for the diagnosis of septic arthritis is low. In this study, the authors developed a machine learning-based diagnostic algorithm for septic arthritis of the native knee using clinical data in an emergency department and validated its diagnostic accuracy. Methods Patients (n = 326) who underwent synovial fluid analysis at the emergency department for suspected septic arthritis of the knee were enrolled. Septic arthritis was diagnosed in 164 of the patients (50.3%) using modified Newman criteria. Clinical characteristics of septic and inflammatory arthritis were compared. Area under the receiver-operating characteristic (ROC) curve (AUC) statistics was applied to evaluate the efficacy of each variable for the diagnosis of septic arthritis. The dataset was divided into independent training and test sets (comprising 80% and 20%, respectively, of the data). Supervised machine-learning techniques (random forest and eXtreme Gradient Boosting: XGBoost) were applied to develop a diagnostic model using the training dataset. The test dataset was subsequently used to validate the developed model. The ROC curves of the machine-learning model and each variable were compared. Results Synovial white blood cell (WBC) count was significantly higher in septic arthritis than in inflammatory arthritis in the multivariate analysis (P = 0.001). In the ROC comparison analysis, synovial WBC count yielded a significantly higher AUC than all other single variables (P = 0.002). The diagnostic model using the XGBoost algorithm yielded a higher AUC (0.831, 95% confidence interval 0.751–0.923) than synovial WBC count (0.740, 95% confidence interval 0.684–0.791; P = 0.033). The developed algorithm was deployed as a free access web-based application (www.septicknee.com). Conclusion The diagnosis of septic arthritis of the knee might be improved using a machine learning-based prediction model. Level of evidence Diagnostic study Level III (Case–control study).

scholarly journals The Ortho-Plastic Approach to Soft Tissue Management in Trauma

2014 ◽  
Vol 8 (1) ◽  
pp. 399-408 ◽  
Author(s):  
Daniel J Jordan ◽  
Marco Malahias ◽  
Wasim Khan ◽  
Sandip Hindocha
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Soft Tissue Injuries ◽  
British Association ◽  
Current Evidence ◽  
Soft Tissue Management ◽  
Initial Management ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
British Orthopaedic Association

Fractures with associated soft tissue injuries, or those termed ‘open,’ are not uncommon. There has been much discussion regarding there management, with the guidance from the combined British Orthopaedic Association and British Association and Aesthetic Surgeons teams widely accepted as the gold level of therapy. We aim to discuss the current evidence about the initial management of this group of injuries, taking a journey from arrival in the accident and emergency department through to the point of definitive closure. Other modes of therapy are also reviewed.

scholarly journals The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence

2020 ◽  
Author(s):  
Elham Monaghesh ◽  
Alireza Hajizadeh
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Healthcare Providers ◽  
Physical Contact ◽  
Current Evidence ◽  
Health Providers ◽  
Search Results ◽  
Effective Option ◽  
Critical Appraisal Skills

Abstract Purpose The outbreak of coronavirus disease-19 (COVID-19) is a public health emergency of international concern. Telehealth is effective option to fight COVID-19 outbreak. The aim of this systematic review was to identify the role of telehealth services during COVID-19 outbreak.Methods This systematic review was conducted through searching five databases including PubMed, Scopus, Embase, Web of Science and Science direct. Inclusion criteria included studies clearly defined role of telehealth services in COVID-19 outbreak, published from December 31, 2019, written in English language and published in peer reviewed. Two reviewers independently assessed search results, extracted data, and assessed quality of included studies. Quality assessment was based on the Critical Appraisal Skills Program (CASP) checklist. Narrative synthesis was undertaken to summarize and report the findings.Results Eight studies met the inclusion out of the 142 search results. Currently, healthcare providers and patients who are self-isolating, telehealth is certainly appropriate to minimizing the risk of COVID-19 transmission. This solution has the potential to avoidance of direct physical contact, provide continuous care to the community and finally reduce morbidity and mortality in COVID-19 outbreak.Conclusions The use of telehealth improves the provision of health services. Therefore, telehealth should be an important tool in caring services while keeping patients and health providers safe as the COVID-19 outbreak.

How to use C-reactive protein

2018 ◽  
Vol 104 (3) ◽  
pp. 150-153
Author(s):  
Emma M Dyer ◽  
Thomas Waterfield ◽  
Hannah Baynes
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Antibiotic Therapy ◽  
Inflammatory Markers ◽  
Biochemical Test ◽  
Current Evidence ◽  
C Reactive Protein ◽  
Paediatric Emergency Department ◽  
Reactive Protein ◽  
Paediatric Emergency

A 3-month-old baby is brought to the paediatric emergency department by their parents because of a fever. You decide to check their inflammatory markers. Their C-reactive protein (CRP) level comes back as 20 mg/L. Does this affect whether or not you start antibiotic therapy? Does it influence your decision to admit or discharge the patient? CRP is a commonly used biochemical test and yet its use is constantly debated and challenged. We look at the current evidence and suggest the best way to use this test in clinical practice.

Adjuvant and Neoadjuvant Management of Colorectal Cancer

2020 ◽  
Author(s):  
Christina E Bailey ◽  
Eduardo Vilar ◽  
Y. Nancy You
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Significant Proportion ◽  
Operative Management ◽  
The United States ◽  
Current Evidence ◽  
Recurrence Rates ◽  
Curative Intent ◽  
Colon And Rectal Cancer

Colorectal cancer (CRC) is the third most common and lethal cancer in men and women in the United States. At presentation, a significant proportion of patients with CRC are able to undergo resection with curative intent, but up to 50% of these patients will develop recurrent disease. Fortunately, recurrence rates for both colon and rectal cancer have improved with the introduction of multimodality therapies, which include chemotherapy, chemoradiation therapy, and radiation therapy. These therapies are adjuncts to surgery and can be administered before (i.e. neoadjuvant) or after (i.e. adjuvant) surgery. This review summarizes the current evidence for the use of adjuvant and neoadjuvant therapies in colon and rectal cancer. This review contains 2 figures, 7 tables, and 77 references. Keywords: Colon cancer, rectal cancer, neoadjuvant therapy, adjuvant therapy, total neoadjuvant therapy, induction chemotherapy in rectal cancer, chemoradiation, organ preservation, non-operative management

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